Armed and Delicate

Baseball pitchers throw far fewer innings and are treated much more carefully than they once were. So why are they getting hurt more than ever?

Author Jack Cavanaugh
Illustration Michael Byers

José Fernández is one of the most exciting young pitchers to have appeared on a Major League Baseball diamond in the last 10 years. Despite being just 20 years old when he made his debut for the Miami Marlins in April of last year, he put together a season that saw him win National League Rookie of the Year and place third in NL Cy Young voting. He was thrilling to watch, with a 98-mile-an-hour fastball, a wicked curve and a charismatic presence on the mound.

But on May 9 of this year, just a month into his second season, Fernández experienced elbow soreness during a rough start against the San Diego Padres.

A few days later, the diagnosis came in: Fernández had torn the ulnar collateral ligament in his elbow, and he would need a ligament replacement operation—known as Tommy John surgery—that would sideline him for the rest of the year.

Fernández isn’t alone. This past April, 15 big league pitchers either had Tommy John surgery or were scheduled to have it. Last fall, Matt Harvey, an exciting young ace with the New York Mets, underwent the procedure, and his 2014 season was also lost to elbow gremlins.

This spate of injuries is even more shocking when one considers that, compared to previous generations of hurlers, today’s pitchers are coddled like pieces of fine china. Fernández has never thrown a complete game in the big leagues, and his career high for pitches in a start is 114.

For comparison’s sake, let’s look at one of the most stirring pitchers’ duels from an earlier era: On June 14, 1974, Nolan Ryan of the California Angels struck out 19 batters in 13 innings, while his counterpart, Luis Tiant of the Boston Red Sox, pitched into the 14th inning, in a game the Angels won 4-3. Ryan threw 235 pitches (no official count is available for Tiant, who likely surpassed 200 himself). And yet neither of these pitchers ever had a serious arm injury. “I had bone chips removed one year, but that was it,” says Ryan, now an adviser to the president of the Houston Astros.

As extraordinary as that pitchers’ duel was, the sight of an idle bullpen during that era was common. Hall of Fame hurlers like Warren Spahn, Sandy Koufax, Ferguson Jenkins and Gaylord Perry all completed more than 20 games in a season at least seven times. (Spahn, who pitched until he was 44, did it 12 times.) Last year, Adam Wainwright of the St. Louis Cardinals led the majors in complete games, with five. Nowadays, few pitchers surpass 200 innings in a season; in 1974, Ryan threw 332.

The question, then, is why are so many of today’s pitchers getting hurt? Many former major leaguers believe it’s because teams are limiting the number of pitches they throw—ironically, in an attempt to prevent injury. “The pitch count hasn’t led to longevity among pitchers but has added to pitchers’ injuries,” contends Ryan, who pitched until he was 46. “It just hasn’t been successful.” Tommy John, the first pitcher to undergo the surgery that carries his name, in 1974, agrees. “There’s no reason why most pitchers can’t go beyond 130 pitches, let alone 100,” John says. “Also, most pitchers nowadays throw only once between games, while I threw every day. That makes a difference.” Ron Darling, a pitcher with the 1986 championship Mets (and now a broadcaster with the team), also disparages the pitch-count doctrine. “It’s the most stupid thing I’ve ever heard,” he says. “They should let pitchers go as long as they can. Now, if they go beyond 100 pitches, they’re ready to call 911.”

Ryan, who in addition to his longevity was one of the hardest throwers of all time, believes that many arm injuries stem from pitchers not having thrown enough when they were young. “Kids don’t organize pickup games on their own as we did, when we played baseball almost all day. Many of them haven’t built up arm strength by the time they reach the big leagues.” Darling agrees. “When I was a kid I was always throwing something,” he says. “If it wasn’t a baseball it was a football or even skimming rocks on the water. That helps build up other muscles. And except for the removal of bone spurs, I never had an arm injury.” Former New York Yankees 20 game winner Jim Bouton, who at age 75 is still throwing his knuckler in a 30-and-over league in Massachusetts, echoes the sentiment. “I’d throw a rubber ball against a wall for about an hour when I was growing up, and we played baseball all day,” he says.

In the medical community, the consensus seems to be that too much baseball at an early age is the problem. Pickup games are one thing, but organized baseball is something else entirely. George Paletta, the former head team doctor for the Cardinals, who has performed more than 500 Tommy John surgeries, says, “This generation of pitchers is paying the price of sport specialization. Kids were much better off when they played multiple sports, rather than just focus on baseball all year. The elbow is not designed for that kind of stress, and an incremental increase in velocity leads to an exponential increase in arm injuries. But that’s what they think they have to do to impress college and big league scouts.”

Many doctors agree that young pitchers are throwing too hard in an attempt to attract the attention of those scouts. The financial incentive is huge, and it also partly explains why teams are so protective of pitchers. Ryan was a 12th-round draft pick in 1965, and he became the first pitcher to earn more than a million dollars a year, in 1979, when he was 32 and had been in the big leagues for more than a decade. When the 18-year-old Fernández was chosen in the first round of the 2011 draft, he received a $2 million signing bonus.

Tommy John agrees with the medical professionals on this one. “At the high school level, they ought to throw the radar guns away,” he says, “because kids are trying to impress scouts by throwing in the 90s.”

So what can be done to stop this trend of injuries? “I’m afraid we’re not going to be able to stop it,” says renowned orthopedist Dr. James Andrews, who has performed more than 1,000 Tommy John operations, including Harvey’s, “unless pitchers learn how to place their pitches better, rather than throw so hard.” Dr. Neal ElAttrache, the team doctor for the Los Angeles Dodgers and a protégé of Dr. Frank Jobe, who performed the first Tommy John surgery, agrees. Pitchers from Ryan’s day, he argues, “knew how to cruise a bit during games and not throw hard for nine innings. That’s not the case today, when most pitchers throw hard for as long as they can. That puts a lot of stress on their arms.” Dr. David Altchek, the medical director for the Mets, goes so far as to say that “the more you throw, the stronger your arm is going to be.” The problem, he says, is “an obsession with velocity.”

Many orthopedists see the problem only getting worse. “Pitchers keep getting bigger and stronger, and more and more throw in the 90s,” ElAttrache says. “Unfortunately, I think we’re going to see even more arm injuries in the future.” Andrews has seen the evidence: “I used to do between five and 10 Tommy John surgeries [in a year],” he says. “I now do between 50 and 100.”

Jack Cavanaugh covered sports for The New York Times for more than 25 years and is the author of six books. His latest, Season of ’42, is about the first World War II baseball season.